Question 1

When should I order a TSH before diagnosing anxiety, and what other medical causes should I screen for?

Accepted Answer

Hashimoto's thyroiditis carries an OR of 2.32 for anxiety (even in euthyroid patients: OR 2.52). The minimum evidence-based workup for new-onset anxiety includes CBC, CMP, TSH/free T4, urinalysis, urine drug screen, and a medication review. Standard Holter monitors miss sporadic SVT in 55% of cases. Expand workup when red flags are present: onset after age 35 without psychiatric history, facial pallor during panic, episodes under 2 minutes with confusion, or treatment resistance beyond 12 weeks.

Question 2

How often is 'anxiety disorder' actually undiagnosed thyroid dysfunction?

Accepted Answer

Hashimoto's thyroiditis carries an OR of 2.32 for anxiety (even in euthyroid patients: OR 2.52). The minimum evidence-based workup for new-onset anxiety includes CBC, CMP, TSH/free T4, urinalysis, urine drug screen, and a medication review. Standard Holter monitors miss sporadic SVT in 55% of cases. Expand workup when red flags are present: onset after age 35 without psychiatric history, facial pallor during panic, episodes under 2 minutes with confusion, or treatment resistance beyond 12 weeks.

Question 3

What's the minimum medical workup before attributing symptoms to a psychiatric anxiety disorder?

Accepted Answer

Hashimoto's thyroiditis carries an OR of 2.32 for anxiety (even in euthyroid patients: OR 2.52). The minimum evidence-based workup for new-onset anxiety includes CBC, CMP, TSH/free T4, urinalysis, urine drug screen, and a medication review. Standard Holter monitors miss sporadic SVT in 55% of cases. Expand workup when red flags are present: onset after age 35 without psychiatric history, facial pallor during panic, episodes under 2 minutes with confusion, or treatment resistance beyond 12 weeks.

Question 4

Should I screen for PCOS in women presenting with anxiety?

Accepted Answer

Hashimoto's thyroiditis carries an OR of 2.32 for anxiety (even in euthyroid patients: OR 2.52). The minimum evidence-based workup for new-onset anxiety includes CBC, CMP, TSH/free T4, urinalysis, urine drug screen, and a medication review. Standard Holter monitors miss sporadic SVT in 55% of cases. Expand workup when red flags are present: onset after age 35 without psychiatric history, facial pallor during panic, episodes under 2 minutes with confusion, or treatment resistance beyond 12 weeks.

Question 5

Does the cortisol paradox in chronic anxiety have any practical diagnostic value?

Accepted Answer

Hashimoto's thyroiditis carries an OR of 2.32 for anxiety (even in euthyroid patients: OR 2.52). The minimum evidence-based workup for new-onset anxiety includes CBC, CMP, TSH/free T4, urinalysis, urine drug screen, and a medication review. Standard Holter monitors miss sporadic SVT in 55% of cases. Expand workup when red flags are present: onset after age 35 without psychiatric history, facial pallor during panic, episodes under 2 minutes with confusion, or treatment resistance beyond 12 weeks.

PsychHQ

Medical Workup Before Diagnosing Anxiety: TSH and Beyond